Thursday, October 9, 2008

How About a Simple "Sorry"?

Today is the Jewish holiday of Yom Kippur, the day of atonement, a day for looking back over the past year and doing some serious self-examination.

It is a day of apology.

As I look back over this past year, which has been awash in instances of deception and greed in medicine, banking, and insurance, I am struck by the lack of apologies.

For example, in response to recent revelations that Pfizer repressed negative data on Neurontin, the company released this statement: “Study results are reported by Pfizer in an objective, accurate, balanced, and complete manner, with a discussion of the strengths and limitations of the study, and are reported regardless of the outcome of the study or the country in which the study was conducted.”

After it became clear that Charles Nemeroff hid vast amounts of income from Emory University, he said: “To the best of my knowledge, I have followed the appropriate university regulations concerning financial disclosures.”

And, responding to evidence that Alan Schatzberg had disclosed only a small portion of his financial interests in a drug company he co-founded, Stanford said: “Stanford University shares Sen. Grassley’s concerns about disclosures of conflicts of interest and ensuring that such conflicts to not influence the conduct of medical research. Based on our extensive investigation to date, we believe that Dr. Alan Schatzbert, a member of the medical school faculty, has fully complied with the university’s rigorous conflict of interest policy.”

We all make mistakes. The process of forgiveness begins with an honest self-assessment.

Teams of lawyers are advising these individuals and institutions that they cannot admit any wongdoing at any time, even as they are surrounded by dense clouds of guilt.

In light of recent revelations, any responsible publisher who is not taking a hard look at the composition of his/her editorial advisory board, is making a grave error. Though not atonement per se, it is beyond debate that changes must be made.

The same goes for publishers of textbooks. For instance, Nemeroff and Schatzberg, who have both been "outed" by Sen. Grassley, have edited several textbooks published by the American Psychiatric Press, an arm of the APA. In these textbooks Schatzberg has talked up his own drug, emphasizing the statistically nonsignificant positive trends in the evidence while downplaying the weakness of his data. There is more on this subject here. http://hcrenewal.blogspot.com/2008/08/commercial-bias-at-stanford-and-corcept.html

Their Textbook of Psychopharmacology is remarkable for giving separate chapters to individual drugs. For instance, all of the major SSRI antidepressant drugs like Prozac, Paxil, Zoloft, and Celexa have separate chapters. For academic entrepreneurs like Nemeroff and Schatzberg with multiple corporate clients, this strategy allows them to showcase all the players in the antidepressant market.

Guess who made sure his name was on the chapter about Glaxo's drug Paxil? Dr. Nemeroff, of course. This allowed him to pimp the use of Paxil in depressed youth, highlighting the infamous and discredited Study 329 led by Martin Keller. What a coincidence that Dr. Nemeroff was leading the Glaxo-Emory-NIH research consortium at the time this textbook appeared. Thus does the academic with a conflict of interest act out the corporate wish to put lipstick on the pig.

James LaRossa is right. Publishers need to take a very hard look at who is on their mastheads and to understand that toxic individuals like these two will not help their bottom lines in the long run.

If perhaps researchers knew that the issue really was financial disclosure, maybe they would apologize. Or maybe not. It seems it's always grandiose folks who make it to the top, anyway. What else is new.

Unfortunately, that's not the real issue here, is it? The issue is the bloodsport of tearing down the validity of medical treatments for brain disorders. And the attack comes from job-insecure anti-science therapists, Scientologists, touchy-feeling types, the Mad Pride contingent, garden-variety misanthropes, and grandstanding politicians.

And I'm still waiting for someone to "out" Grassley. I wrote to NYTimes Gardiner Harris, to ask why he never "follows the money" regarding Grassley and his aides/hitmen. That would include mentioning that Grassley's number 2 campaign donor is Blue Cross/Blue Shield (as I've mentioned here before). He responded, "I don't understand the connection." sigh

Who needs insurance-company lobbyists when they're employed by a US Senator?

It's ironic, because if the researchers' work was taken more seriously by broader groups of the public, perhaps some of the Masters of the Universe who got us into this financial meltdown would have long ago been treated medically for their greed and narcissism. (Yes, empathy is a function of the brain, and in many cases, medication can boost empathy). Or at least, they would not have self-medicated so heavily with money and greed, always needing more more more to satisfy a limbic system unrestrained by a strong prefrontal cortex.

But what's another limbic system hotspot? Revenge. And hell hath no fury like talk therapists and insurance companies when their pocket book is threatened.

1. I'm sure Senator Grassley is not being altruistic and only safeguarding the public's interests with his "investigation".

Insurers are as much if not more the enemy in health care, but moreso for mental health as their efforts to gouge out monies were first explored here. If there is truth to how much lobbying is done by them through Grassley, this needs investigated too!

2. Sorry to say one cannot treat greed and narcissism, in my experience, as the protagonists have to want change, and isn't that incongruent with these disorders? Even the bottoms we are observing financially are not felt by the entrenched culprits.

Empathy is not in the vocabulary at Wall Street, banks, and any addicts' brain. Nor do they deserve it from those who do know and practice the term.

3. Talk therapist these days want prescribing privileges, so in my opinion, they want psychiatrists to fail so they can step in and allegedly handle meds better.

HA HA HA!

Psychologists getting prescribing privileges will find this pursuit to be their downfall. Count on it! Revenge can blind one to the realities of life. Psychiatrists are screwing themselves with this narrow perspective in care. You would think a competitive profession would see that. But, addiction has no boundaries, professional as well.

4. I would like to read something of valid substance and legitimacy that shows meds can impact positively on improving, or creating empathy. Strange, I always thought and observed it to be taught, modeled, and fostered.